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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2020

Open Access 01-12-2020 | Acute Kidney Injury | Research article

Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury

Authors: Megan Howarth, Meha Bhatt, Eleanor Benterud, Anna Wolska, Evan Minty, Kyoo-Yoon Choi, Andrea Devrome, Tyrone G. Harrison, Barry Baylis, Elijah Dixon, Indraneel Datta, Neesh Pannu, Matthew T. James

Published in: BMC Medical Informatics and Decision Making | Issue 1/2020

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Abstract

Background

Acute kidney injury (AKI) is common in hospitalized patients and is associated with poor patient outcomes and high costs of care. The implementation of clinical decision support tools within electronic medical record (EMR) could improve AKI care and outcomes. While clinical decision support tools have the potential to enhance recognition and management of AKI, there is limited description in the literature of how these tools were developed and whether they meet end-user expectations.

Methods

We developed and evaluated the content, acceptability, and usability of electronic clinical decision support tools for AKI care. Multi-component tools were developed within a hospital EMR (Sunrise Clinical Manager™, Allscripts Healthcare Solutions Inc.) currently deployed in Calgary, Alberta, and included: AKI stage alerts, AKI adverse medication warnings, AKI clinical summary dashboard, and an AKI order set. The clinical decision support was developed for use by multiple healthcare providers at the time and point of care on general medical and surgical units. Functional and usability testing for the alerts and clinical summary dashboard was conducted via in-person evaluation sessions, interviews, and surveys of care providers. Formal user acceptance testing with clinical end-users, including physicians and nursing staff, was conducted to evaluate the AKI order set.

Results

Considerations for appropriate deployment of both non-disruptive and interruptive functions was important to gain acceptability by clinicians. Functional testing and usability surveys for the alerts and clinical summary dashboard indicated that the tools were operating as desired and 74% (17/23) of surveyed healthcare providers reported that these tools were easy to use and could be learned quickly. Over three-quarters of providers (18/23) reported that they would utilize the tools in their practice. Three-quarters of the participants (13/17) in user acceptance testing agreed that recommendations within the order set were useful. Overall, 88% (15/17) believed that the order set would improve the care and management of AKI patients.

Conclusions

Development and testing of EMR-based decision support tools for AKI with clinicians led to high acceptance by clinical end-users. Subsequent implementation within clinical environments will require end-user education and engagement in system-level initiatives to use the tools to improve care.
Appendix
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Metadata
Title
Development and initial implementation of electronic clinical decision supports for recognition and management of hospital-acquired acute kidney injury
Authors
Megan Howarth
Meha Bhatt
Eleanor Benterud
Anna Wolska
Evan Minty
Kyoo-Yoon Choi
Andrea Devrome
Tyrone G. Harrison
Barry Baylis
Elijah Dixon
Indraneel Datta
Neesh Pannu
Matthew T. James
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2020
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-020-01303-x

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